British Journal of Renal Medicine - 2015

Comment: The art of renal medicineJohn Bradleypp 87-87Hospital environments should promote the health and well-being of patients and staff, helping to alleviate the anxiety associated with a stressful environment. Aesthetics within a hospital are an important but often neglected area, despite increasing evidence of the positive impact the arts can have.

Acute kidney injury in vascular surgery: a quality improvement studyJason Ramsingh, Milos Prica, Hollie Coleman, Kamran Khatri and David Kingsmorepp 88-92It is well established that acute kidney injury (AKI) is associated with increased morbidity and mortality, and is a marker of the quality of care delivered to patients. AKI is prevalent, affecting 7–23% of hospitalised patients worldwide. Although various classifications of AKI severity exist (such as the Risk, Injury, Failure, Loss, End Stage [RIFLE] and Acute Kidney Injury Network [AKIN] classifications), the lack of a standardised definition could lead to under-reporting of its true incidence in published studies. The Kidney Disease Improving Global Outcomes criterion is an amalgamation of the RIFLE and AKIN criteria, and aims to reduce heterogeneity and improve clarity of reporting. It is recognised that increasing severity and duration of AKI lead to poorer outcomes, most commonly the development of chronic kidney disease, need for renal replacement therapy and poor survival.

Building the science of deliveryDonal J O’Donoghuepp 93-94Whether we are talking about delaying progression of kidney disease, reducing acute kidney injury rates or the global challenge of diabetic kidney diseases, the real constraints are often not the basic scientific knowledge or clinical evidence but, rather, our continued inability to effectively deliver the treatments and interventions we already have. We need to decide that the science of delivery (or improvement, or quality, or whatever we want to call it) is every bit as important as molecular mechanisms of disease or clinical epidemiology, and just as essential for a sustained impact on health outcomes.

Improving the environment for kidney patientsKerry Tomlinsonpp 95-97When the North Staffordshire Royal Infirmary closed in 2012, the renal department was lucky enough to move into a new purpose-built unit at Royal Stoke University Hospital. The new kidney unit includes an acute ward, haemodialysis unit and outpatient area. During the build, a multidisciplinary stakeholder group, consisting of architects, builders, project managers, patients and clinicians, was formed to oversee decisions such as those on layout and room contents.

What I tell my patients about self-managementFergus Caskey, Barnaby Hole, Sumira Riaz, John Weinman and Neil Turnerpp 98-100Self-management of your healthcare and everyday life can help to prevent the progression of chronic kidney disease. However, many patients find it difficult to self-manage their condition. Fergus Caskey and colleagues provide advice on things you should think about

Autosomal dominant polycystic kidney disease: past and futureRosie Loftpp 101-102Autosomal dominant polycystic kidney disease (ADPKD) affects about one in 1,000 people worldwide. In the UK, around one in ten people receiving renal replacement therapy have ADPKD. It is the most common inherited kidney disease, caused by mutations in PKD1 or PKD2. There is a fifty–fifty chance of an affected parent passing ADPKD on to their children.

Renal complications of IgG4-related diseaseRebecca Herbert, Simon Freeman, Dean Harmse and Andy Connorpp 103-106IgG4-related disease (IgG4-RD) is a multi system disease, which often mimics alternative pathologies resulting in unnecessary invasive investigations and delays in diagnosis. IgG4-RD is a rare condition with an estimated prevalence between 0.28–1.08 per 100,000 population. However, it is only recently that the clinical, serological and pathological features of the disease have been unified to a single disease entity and as such it is likely that it is underdiagnosed.

A specialist nurse service for patients with acute kidney injurySarah de Freitas, Sarah Neilson, Julie Darroch, Funmi Akinlade, Peter Ayling, John Cooil and Ajith Jamespp 108-110Acute kidney injury (AKI) is associated with a high risk of morbidity and mortality, as highlighted by the National Confidential Enquiry into Patient Outcome and Death in 2009. Mortality rates are associated with disease severity, with mortality being at least twice as high in patients with AKI stages 2 and 3 (>30%), compared with those with stage 1.

The British Journal of Renal Medicine was previously supported by Baxter Healthcare from 2011 to 2013, by Sandoz in 2011, by Shire Pharmaceuticals from 2006 to 2011, by Ortho Biotech and Shire Pharmaceuticals in 2005, by Ortho Biotech from 2000 to 2005 and by Janssen Cilag from 1996 to 2000.

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